肥胖女性孕期增重速率及其与巨大儿发生风险的相关性  

Weekly gestational weight gain in women with obesity and its association with risk of macrosomia

作　　者：宋伟[1] 郑薇 王小新[1] 郭翠梅[1] 梁胜男 李光辉[1] Wei Song;Wei Zheng;Xiaoxin Wang;Cuimei Guo;Shengnan Liang;Guanghui Li(Department of Perinatal Medicine,Beijing Obstetrics and Gynecology Hospital,Capital Medical University/Beijing Maternal and Child Health Care Hospital,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院/北京妇幼保健院围产医学部,北京100026

出　　处：《中华围产医学杂志》2023年第7期575-583,共9页Chinese Journal of Perinatal Medicine

基　　金：国家自然科学基金 (82171671)。

摘　　要：目的:探讨肥胖女性的孕期增重速率,以及该增重速率与巨大儿发生风险的相关性。方法:回顾性分析2014年1月至2019年12月就诊于首都医科大学附属北京妇产医院/北京妇幼保健院的单胎、孕前体重指数(pre-pregnancy body mass index,PPBMI)≥28 kg/m^(2)的孕妇的临床资料。根据PPBMI将研究对象分为A组(PPBMI 28~<30 kg/m^(2))、B组(30~<32 kg/m^(2))和C组(≥32 kg/m^(2))。比较3组研究对象的孕期增重速率,以及各妊娠阶段的增重速率与巨大儿发生风险的相关性,探讨不同PPBMI人群增重速率对巨大儿发生风险的影响。使用χ^(2)检验(或Fisher精确概率法)、Kruskal-Wallis检验或Mann-Whitney U检验进行统计学分析。采用多因素logistic回归分析特定妊娠阶段增重速率对巨大儿发生风险的影响。结果:(1)共2046例最终进入本研究,A、B、C组分别为982、588和476例。2046例孕妇PPBMI 30.1 kg/m^(2)(29.0~31.9 kg/m^(2)),孕期增重10.5 kg(7.3~14.0 kg),其新生儿出生体重3520 g(3215~3816 g),318例(15.5%)发生巨大儿;60例(2.9%)出生体重≥4500 g,最大为5580 g。(2)A、B和C组孕妇的年龄[32.0岁(29.0~35.0岁)、32.0岁(29.0~35.0岁)与32.0岁(29.0~34.0岁),H=6.58]、有2型糖尿病史的比例[0.9%(9/982)、0.3%(2/588)与1.9%(9/476),χ^(2)=6.61]比较,差异均有统计学意义(P值均<0.05)。(3)3组孕期增重速率在孕20~24周以前呈现逐渐上升的趋势,孕24~32周呈现平台期,孕32~36周出现高峰,随即降低。A组在孕前至孕14周[0.14 kg/周(0.00~0.25 kg/周)]、孕14~20周[0.25 kg/周(0.17~0.42 kg/周)]和孕20~24周[0.38 kg/周(0.25~0.63 kg/周)]的增重速率均高于B组[分别为0.07 kg/周(-0.03~0.21 kg/周)、0.25 kg/周(0.10~0.42 kg/周)和0.38 kg/周(0.22~0.60 kg/周),Z值分别为-3.73、-2.16和-2.01,P值均<0.05];B组上述时间段的增重速率亦均高于C组[分别为0.07 kg/周(-0.10~0.21 kg/周)、0.17 kg/周(0.05~0.33 kg/周)和0.25 kg/周(0.08~0.50 kg/周),Z值分别为-2.55、-3.28和-3.25,P值均Objective To explore the characteristics of weekly gestational weight gain(GWG)in women with obesity and its correlation with the risk of macrosomia.Methods Clinical data of women with singleton pregnancy and pre-pregnancy body mass index(PPBMI)≥28 kg/m^(2) were retrospectively analyzed,from January 2014 to December 2019,in Beijing Obstetrics and Gynecology Hospital,Capital Medical University(Beijing Maternal and Child Health Care Hospital).The participants were divided into three groups based on their PPBMI:group A(28-<30 kg/m^(2)),group B(30-<32 kg/m^(2)),and group C(≥32 kg/m^(2)).The study compared the characteristics of GWG among the three groups,explored the correlation between the weekly weight gain during each gestational stage and the risk of macrosomia,and discussed the impacts of the GWG pattern in women with different PPBMI on the risk of macrosomia.Chi-square(or Fisher's exact),Kruskal-Wallis,and Mann-Whitney U tests were performed for statistical analysis.Multivariate logistic regression was used to analyze the impact of weekly weight gain in specific gestational stages on macrosomia.Results(1)A total of 2046 participants were included in the study,with 982 in group A,588 in group B,and 476 in group C.For all of the 2046 cases,the median PPBMI was 30.1 kg/m^(2)(29.0-31.9 kg/m^(2)),GWG was 10.5 kg(7.3-14.0 kg),and neonatal birth weight was 3520 g(3215-3816 g)with 60(2.9%)≥4500 g,and the biggest baby weighed 5580 g.Out of the births analyzed,macrosomia occurred in 318 cases(15.5%).(2)Among the three groups(A,B and C),the differences in maternal age[32.0 years(29.0-35.0 years),32.0 years(29.0-35.0 years)and 32.0 years(29.0-34.0 years),H=6.58]and women with a history of type 2 diabetes mellitus[0.9%(9/982),0.3%(2/588)and 1.9%(9/476),χ^(2)=6.61]were statistically significant(all P<0.05).(3)The weekly weight gain in each group exhibited a gradual upward trend before 20-24 weeks,reached a plateau at 24-32 weeks,peaked at 32-36 weeks,and subsequently declined.The weekly weight gain of group A in the p

关 键 词：肥胖症 孕期体重增长 巨大胎儿 危险因素 

分 类 号：R714.256[医药卫生—妇产科学]